Stories from Mbweni

During the last years, Associazione Ruvuma Onlus kept on carrying out its activities, interpreting in the widest way the objective to give to the Tanzanian population a better access to Health and professional training, in the Hospital – both in the Hospital – asking to the Italian volunteers to carry out their activity together with their Tanzanian colleagues – as well as providing every year scholarships to the students of the Professional School of Mtongani, or getting involved in other projects subsequently carried out by other organisations and people.
It’s important and comforting to remember that, in Tanzania like in the rest of other African countries, many Italian laics, individually or with the collaboration of other Congregations and Missionary Orders, voluntary dedicate their time to carry out any sort of jobs and train the local population with different manual activities: woodworkers from the Brianza area, metalworkers from Tuscany, carpenters from Veneto and bricklayers from Bergamo, all of them make formidable, as well as homogenous, humanity, sharing the common desire to bring help and solidarity to the poor of Africa.

Milena Cimatti, nurse

I have been dreaming of an experience in Africa since ever, and thanks to Associazione Ruvuma I was able to visit the hospital in Mbweni, Tanzania. It’s a well organized hospital, offering many services, from radiology to maternity and pediatrics. All staff working there are always smiling and happy to talk. The day begins at 7 am, when in the background you start hearing the voice of the children arriving the school. Not all of them can afford to take a bus, and many just walk for hours to reach the school. This is also Africa. We volunteers get together for breakfast, and the first days people are always a bit shy, but after few days everything change, because the motivation for coming here is strong and shared by all of us, then the collaboration become stronger. At the end of the breakfast, we wear our uniform and go to the hospital. First thing I do when arrive is entering the operating theatre, and after saying hello to the girls I go to visit all patients operated in the previous day. While I walk along the corridors, I see in the room the nurses talking with patients. They speak in Swahili and I can’t understand what they are saying, but from the voice I can understand is a quiet dialogue. These images enter in my mind, I wish one day to be able to see the same scenes also in the Italian hospitals, which have more and more a frenetic rhythm in the everyday work. At the end I enter in the operating theatre, the surgeons are washing their hands, all steps followed in every hospital, of course, but here they have a different aspect, it’s like compare to the Italian hospital there is less bureaucracy in the procedures to follow. Even in Tanzania all the necessary rules are followed, but here it’s seems like if everything is simpler. At the end of the working day, we volunteers meet together, it’s an important moment to share our experiences and to express our ideas, thoughts and emotions. Being catapulted in a reality similar to the one you are used to live, but at the same time so much different, bring back to memory how much those small daily gestures, like for instance a simple greeting, a shake of hand, are not only rituals coming from being polite but get a most important meanings, it means taking care of others. Days go on and at the end I don’t know how much I give to them, but I know how much they have given to me.

Davide Falcioni, journalist and photographer

Josephine was 13 years old. One day she propose me to bring me around in Mwbeni, in the homes of family’s home where I wanted to take some pictures. I knew very well that I should have somehow rewarded her for that, then, at the first kiosk of drinks we found I bought two Pepsi: one for me and one for her. Josephine therefore brought me in the small shacks of the villagers of Mbweni. Every time she would introduce me, explaining – I suppose – that I was a photographer collaborating with Associazione Ruvuma and that I was with the team of the doctors, and every time they would welcome me with a smile. I would ask them to be as natural as possible, and keep on doing their normal activities, like cooking a bowl of rice, taking the water from the well and so on, without caring of me and my camera. I wanted to document life around the hospital, that was my objective. Our round among the family went on for hours, with Josephine willing to enter every home and make her introduction for me. I offered her another Pepsi, I also bought a drink to another dozen of children who arrive to play with me. At the end I brought back her home Josephine. There, I met her mother, washing some clothes, the father was sitting just next to the door. The offered me a drink, which I kindly refused because I knew that water was not drinkable. Josephine then sat next to her father, looked at him and made a gesture between themselves, then her father look at me and said: “Well, my friend, now that you have been with Josephine all this day, would you like to marry her?”

Federica Sfogliaferri, doctor specialized in anaesthesia

It has been all my life I wanted to make an experience in Africa, and I finally I did it! Thanks to my friend and colleague “Babu”, Doctor Giuseppe Travaglini, I had the opportunity to know the hospital of Mbweni. To describe what I felt is not easy because the emotion was so strong that every word would risk to appear banal. It’s what you see, what you live, that make you feel important, not so much because you are able to do more or because you know more advanced technologies, but for the relationship that are born during that time, simple, real and true. For sure, you don’t have the perception of time like in Western hospitals, and in this way you have the time to listen, to smile and being spontaneous in the human relationship. Working in Mbweni is different from Italy: less technology and advanced procedures but for sure a great respect for the ill person, with his or her acceptance of the illness and the awareness of the proportions of the cure he or her will receive. An example of what I’m saying is the case of a 10 years old girl, suffering brain malaria. According to our Western standard the actions to take with her were intensive therapy, but what after? Who would have been able to assist her in case things got worse? I felt powerless, I didn’t have the technology I’m used to have and I was afraid the child could not make it, but at the end, and I’m so proud of it, she completely recovered and was able to go back home. My role in all this experience? I did a bit of everything and nothing. But I hope, at least, to have been useful in keeping on the training project so that the local staff will be able to work efficiently even when we will leave.

Cosimo Bleve, pediatric surgeon

Doctor Cosimo Bleve, pediatrician and surgeon who participated to the Professor Franchella’s mission, shared with us as a personal diary his experience of those 20 days at the Mbweni Hospital. Here is emotional story and some images of the mission and the team at Mbweni.The mission in Tanzania has just finished and, as every time, you find yourself thrown in a reality that raises an uproar of emotions and reflections, something you feel inside, that stories, pictures are not able to describe in its
fullness. And every time is like if it was the first time. For me, this is my eight mission in the last five years. Missions or better to say life experiences I participated thanks to Doctor Franchella who offered me the opportunity, first as training doctor and then as Specialist in Pediatric Surgery, to make available the professional competences gained
in my work in favour of the most disadvantage populations. What drive you with motivation as a volunteer is the possibility and opportunity to do something for those people less lucky than you, and in our case for those you are part of the most vulnerable part of the population: children, our future. Tanzania is one of the poorest country in the world. 60 per cent of the population live with no electricity and the 40 per cent with no drinkable water. Also, 60 per cent of the people there live with less than 2 dollars a day, while the infant mortality rate during the first five years
of age is still very high. During the mission we collaborate with Associazione Ruvuma Onlus at the Mbweni hospital, located in a village almost 50 km from the biggest city Dar Es Salaam, on the coast of Tanzania. We surgically operated 39 children in less than two weeks, not a big number compare to the population, still, not only a number but Small Patients for whom we were able to do something to improve their lives. What strike me of these people is that despite poverty, they are so rich in dignity in the way the live their illness, or waiting for their turn to be visited, eating sitting on the ground, walking sometimes even for days to reach the hospital. Together with the joy and gratitude in the faces of the parents of the operated children, there was however also the polite resignation of those we could not operate. In fact, in the area of the screening implemented on a daily basis, it has been necessary, with courage and regret, to take the decision not to proceed with the operation for certain patients. It’s always difficult to communicate to the family such a decision, but in this mission it has been hardest that in the other ones, especially with those little patients affected by serious disease. To look in the eyes a 14 months years old baby and tell her mother we cannot operate her but that the best solution is not to proceed, is something that make you feel powerless. Some pathologies, unfortunately, would require follow-ups impossible to guarantee as it happen in Western countries. Even if I know that
it would be impossible to change the life of everybody, at least I know we helped the life of 39 children. It’s true, it’s just a small drop in the ocean, but at the end the ocean is made by billions of drops. And it’s exactly for this reason that a young doctor like me try to give his contribution to help those who are more vulnerable.

Ambrose Temu, Doctor

Since the day Associazione Ruvuma Onlus became operative in Mbweni with the S. Maria Nascente Hospital, one of the main objectives, beside offering health assistance, has always been to train local doctors to become professionally autonomous. This part is carried out sending periodically on the place Italian doctors who back up the Tanzanian ones. Associazione Ruvuma, moreover, finance the specialization studies of his staff, like for instance the three years Master Doctor Ambrose Temu attended at the Muhimbili University, connected to one of the best hospital in Dar Es Salaam.

In the last years, the Mbweni Hospital has been coping with an increasing demand for the request of health assistance. As a result, the quality of the service offered must be able to offer the best efficiency and know-how for the more numerous patients. Periodically, at the hospital arrive many doctors from Italy who share with us their skills. They are used to operate in environments who offer sophisticated equipments and technology of the last generation, something that is not always available here. Moreover, some of them also brings specialized knowledge. In Tanzania, instead, training is multidisciplinary and provide in the same training path different specializations. And the result of this is less competence. Having said that, asking Dr. Rodriquez and Doctor Travaglini the opportunity to keep on with my studies at the Muhimbili University of Health and Allied Sciences has not been a difficult decision to take. Thanks to them and to Associazione Ruvuma Onlus I have been able to add to my studies other three years with a Master in General Surgery, something that will give me the possibility to go back working in the Mbweni Hospital and offering a better service. I graduated at the Muhimbili University in 2006 and I did my internship in the regional hospital of Iringa for one year. Then in 2008 I have been hired by the Mbweni Hospital where I had the opportunity to work with the excellent urologist and surgeon Giorgio Giaccaglia. In 2009, I also attended a specialization course of three weeks in laparoscopy surgery, in an Institute in Naples and in the European Surgical Institute of Hamburg, in Germany. This course for me meant a lot, it has been a gold opportunity which filled my heart with joy and many more inspirations. We have to deal with a lack of resources, in terms of staff than equipment. Sometimes, it can be a problem even only to make a correct diagnosis. Just to make an example, only three governmental hospitals in the country have an ultrasound machine to make a TAC. Only few hospitals have an ambulance. Yet, to work at the Mbweni Hospital is fantastic. It’s a simple structure, with few beds and three operating theatre. Its personnel is humble and full of love and respect towards all their patients. Usually the working day starts at 8 in the morning, when patients arrive to be visited. We give priority to the emergencies, like for instance those who must be operated. But above all, we are proud of our Maternity Department, which offer a pre and post natal service. If there are complications, the most serious cases are sent to the Muhimbili National Hospital with an ambulance.

Jeannine van den Heuvel, 46 years old, tells her experience (personal and professional.In our Santa Maria Nascente’s Hospital, in Mbweni. Jeannine is specialized in Pediatrics-Neonatology, she has Dutch origins and has been living in Naples since 23 years.To be able to do a professional experience in Africa is a dream I have been having since 10 years. In 2008 I decided to start doing something practical to realize this dream. And then it happened! During that year I follow a course in Tropical Medicine in Torino and one year after I finally participate to my first misson in an african hospital in Benin.
Last november 2009 it has been my second african experience. Thanks to the friend and colleague Doctor Carlo Molino, a surgeon from Naples, I had the opportunity to visit for the first time the hospital in Mbweni, during the opening ceremony of the new maternity ward. There I met as well Doctor Giuseppe Travaglini, health director of the hospital and Dr. Rodrigo Rodriquez, the founder of the Ruvuma Association and who has conceived the beautiful project of Mbweni. With both of them I was from the beginning in perfect tune, I realized that we were sharing the same commitment for the achievement of the right to health.The experience of Mbweni has been very formative, from a professional and human point of view. In particular I realized that in many areas of Africa, maternity and Pediatrics still have many gaps. In fact, when I left, after few days from my arrival in Italy I already wish to go back there to help, but above all to “teach” and train the medical staff who work in the maternity ward. Therefore in april I went back to Mbweni with many protocols and guidelines relative to the specialistic areas of Pediatrics and Neonatology defined by the World Health Organization. Together with local doctors we studied them, adapting of course to the local reality. I also had the pleasure to place side by side, trying to convey as many notions as possible, a tanzanian colleague, Doctor Rehema, who very soon will become a pediatrician. That of Mbweni has been an experience that I will never forget and that I wish to all my colleague to be able to do it, sooner or later in my life.

Ester Galli, obstetrical

Ester is a young Italian obstetrician who decided to dedicate few months of their lives to make an experience as volunteers in our hospital in Mbweni. She was in Mbweni from November 2009 until May 2010. From Tanzania she tells us her experience.I have always wanted to make an experience in Africa. Here emotions are very different, often there are feelings which you experience and which are contradictory among them. For sure the relationships which one’s establish in this place with women, are very special. They are based mainly on a non-verbal language, since we cannot communicate in Swahili. I will never forget the day I met a young woman who was in pain and very scared since she was about to delivering her baby and in a simple way, calling me “friend” asked me to stay close to her to sleep under a tree all night, just to keep her company. Working in an African hospital is completely different from working in an Italian one. Of course ethics and expertise are the same, yet the culture is so different that does not allow a real hospitalization for patients illnesses and diseases, meaning that a woman waiting a baby cannot receive the same assistance that would get a woman living in any western country. Then often you meet some clinic situations that are serious and that in any other European country could have been avoided. They are two different worlds that meet each other, and that have a lot to teach and learn one with the other. Relationships among colleagues and patients are true and spontaneous. You never have the feeling that they are false and you are really happy if you see that the other person is fine. Even in Italy often there are good working team where you can also develop friendship, but here is quite different. Every single thing you live during the day is truly lived, and is something that even when you finish your working day you still keep on thinking to it.

Federica Malberti, obstetrical

Federica is a young Italian obstetrician who decided to dedicate few months of their lives to make an experience as volunteers in our hospital in Mbweni. She was in Mbweni from November 2009 until May 2010. From Tanzania she tells us her experience.Since I’m here I have been living many situations from a professional and human point of view that I would never think I could experienced in Italy. What really surprised me is the strenght of these women when they are delivering a baby. And the dignity with wich, in a silent way, they suffer and deal with the strain and pain without asking for nothing. They even are surprised when you stay with them to cure and support taking the place of their husband or a relative. They call you “dada” (in Swahili means sister) and when you are about to leave they ask you to stay with them a little bit more. Words are really limited since they cannot speak English and we cannot speak Swahili, but it makes no difference, relationships are even stronger in this way. It’s very different to work in an African hospital compare to an Italian one. Because of the lack of health assistance most of these people develop serious diseases that could have been prevented. I’m very happy to have the opportunity to work in Mbweni for so many months since some of the cultural aspects can been understood just after months of listening and observing that reality. Another thing I noticed is the different working environment from a human point of view. Here I felt immediately accepted, everybody always smile at you and ask if everything is ok. You don’t even feel the hierarchy with your boss and a doctor and a cleaner or a nurse are really on the same level. Nobody never raise the voice and everybody is always very polite and always say thanks. Something that we should learn to do it also in Italy. Yet, to understand what I’m saying one’s should try to stay here in Africa for at least few months. Africa is a difficult place to describe. Only living it, and with the willingness to really discover it with humility, you can see all the different facets.

Floriana Monti, volunteer

Floriana is a precious friend and collaborator of Associazione Ruvuma Onlus, share with us her experience at the Mbweni hospitalWhen I initially started collaborating with Ruvuma, I did fund raising for their hospital in Mbweni, keeping in my mind the thougth that it would just be a small drop in the ocean. I was convinced that poor people were those who didn’t have material assets, because I still didn’t realize that we are the poor, with our conscience soothed by the so named civilization, who are not capable of smiling anymore, just committed to make more wealth and unable to be happy of the simple things of life, like for instance the smile of a child. ?All this lasted until I decided to go to Mbweni, where, since the beginning, I felt home. One thousand words would not be enough to describe the emotion I felt when, on the first day of my arrival in Tanzania, a child from the school got closed to me and, in silence, took my hand and smile at me, few minutes after other 10 or 20 children arrived, with the same smiling light in their eyes, that light that only children have and reach the heart of people who look at them. ?That part of Africa in which I have been lucky to stay, it appeared to me different from other places of Africa I have previously been as a tourist, maybe because I didnt’ get to know deeply people who live there, in their homes, I didn’t see all ill people who everyday to to the hospital with illnesses and problems of health to me unknown. ?When I got back from my first journey, I promised to myself to go back, and in fact after two months only I was already there, and then I keep on going back, everytime staying for longer amount of time.?When I’m in Italy I think often to the hospital and all the projects to improve and enlarge it, in which, by now, I feel totally involved. I think also to all the amazing people I meet evertime who work as volunteer or collaborators there and that from Italy, periodically, go there to work. I have seen them in action in the operating theatre, at day and at night, never complaining. ?At this point I feel totally linked to that place and to its people, and I will never stop saying “thank you Mbweni” for all what you gave to me and keep on doing it. And also, thanks to RUVUMA, for the opportunity you gave me to carry out this beautiful experience.

Daniel Muganyizi, director of the Santa Maria Nascente Hospital

With the new management entrusted to DMI, our Mbweni Hospital had a new Director. We have the pleasure to present him in this Newsletter, with a short interview. Doctor Daniel Muganyizi (in the picture) arrives at Mbweni after a two years experience as Responsible of the Mubuda Dispensary, in South Africa, and one year experience in the hospital of Temeke, in Tanzania.

I wanted to engage into a new challenge. Mbweni, since long time, is already an excellent hospital, where periodically interchange really good Italian doctors. It can also relies on efficient equipments, thank to the support of Associazione Ruvuma Onlus. Now, my objective is to see that this hospital can further distinguish in all the country, becoming a landmark also for patients who live in more distant areas. And this hospital has all the potential to become it, both for the quality of its health services than for the expertise of those who work in it. Another challenge will be that of making all this available at costs that the population is being able to tackle. The weakest point of the S. Maria Nascente Hospital in Mbweni is the place where is located, namely the lack of transport arriving here, since the public transport service of bus, the dala dala, ends at 20:00, and the distance from the main road Dar Es Salaam – Bagamoyo is of six kilometres. Luckily, this road has recently been enlarged and improved for a better viability. Yet, despite the difficulties that remain to reach the hospital, patients of S. Maria Nascente are always more numerous, also thanks to the ratio that we guarantee between costs (the poorest patients don’t have to pay) and the quality of the offered health services. But not only this, when I talk about service, I don’t refer only to the medical one but also to the attitude and the human approach of all the personnel and the charitable Sisters towards all patients. Sure, there is still much to do to improve it. But this hospital, as I told earlier, had all the potential to become one of the most efficient of the area, even thanks to the faith, courage and efforts of all those people who since long time give to it both on the field than from Italy.

Laura Mezzasoma, volounteer

The day before the departure for Mbweni, is the hardest moment: to weight the luggage keeping the finger cross, hoping they are not too heavy for what you are allowed to bring on the plane. And we have a special luggage: X-rays from the mammography, medicines and… Ann! We decided to bring her with us, for her first long journey of her life. Our little Ann, we hope not to have trouble at the airport because of her, in that case, we would be willing to leave there everything, but not Ann. She weight around 5 kilos, is made of a resistant material and, above all, functional. Ann is a puppet on which the staff of the Mbweni hospital will train to put into practice the activities of emergency room. In fact, we are going to Mbweni because the doctor coming with us organised a course of Basic Life Support at the hospital. And for this reason, is vital to have Ann with us. We arrive in Mbweni and immediately we prepare everything for the forthcoming training course. The next day we are ready and the waiting room start transforming: a sheet hung to the wall to project the slides, Ann lying on a bench. Doctors and nurses ready to start. Thanks to Dotto, one of the doctor of the hospital who speaks English, we can translate to everybody all the steps to follow, and each of them start to exercise in saving Ann. We managed to carry out the full training with excellent results. Now, unfortunately, the moment to leave and return to Italy arrive, and this time our luggage will be less heavy because Ann will remains in Mbweni.

Elena Monti, student of Medicine

This morning, like all the other days, since I arrived here two weeks ago, my alarm clock is the voice of the kindergarten children. This is the last day for me in Mbweni. It was long time I wanted to make this experience in the Hospital S. Maria Nascente of the Associazione Ruvuma Onlus. As a student of Medicine I was curious to experience a reality so different from ours, how could be the life in Africa, and above all, how it was an African hospital. And finally the opportunity arrived. I didn’t know what to expect. For sure, what I found here is much above my imagination. Mbweni is a small village, not distant from the capital. A recently paved road run along the village, next to it, there are many huts, stands selling food, and also few houses in concrete. And finally, here come the hospital, a point of reference for the village. At the entrance, a group of Masai open an improvised gate made by a rope. The S. Maria Nascente Hospital is made by different clinics, maternity departments and two operating theatre. Every day many people from the nearby villages reach Mbweni and its hospital. The staff of the hospital, most of them local, work with enthusiasm and competence. My main help as volunteer was that to help Sister Generosa, together with Federica, another volunteer, in organizing the warehouse and the pharmacy. And we get to know Salvatore, an handyman who with simple tools is able to solve any kind of problem and satisfy all our requests. As all Tanzanian, Salvatore follow the philosophy of the “Pole Pole”, namely doing things slowly, and in this way you are able to do everything with success. It’s so different from our culture, but is so true! I also have the possibility to be for few days in the operating theatre. The nurses are all very competent: Regina, Lucy, Marisela. Same for the anesthetists. I meet also Ambrose, a surgeon who studied abroad thanks to Ruvuma, and is a very capable doctor. The welcome all of them gave me was unique. In Italy, during the period of training I had some experience in the operating theatres. Usually students are kept far away from the operating table, this doesn’t give you the opportunity to actively participate to the operation. But here in Mbweni, not only they allowed me to stay close to the doctors, but also to make questions and actively be part of the team. This is a memory that will always be in my heart. Like the one when the camper sent from Italy to carry out the mammography arrived. We worked hard to make it work and the result was really rewarding. I thank the Associazione Ruvuma to have given me the possibility to live this experience.

Barbara Contini, President of the Italy-United States Foundation

On that day in Dar es Salaam was a sunny day and the sea was calm. Children screamed with joy when they saw us arrive, and run everywhere in the garden of the hospital, making it seem like a playground. The air was clean and the volunteers was happy to work to make the hospital better. Everybody smiled and some elderly people keep on watching us while we entered. The Cardinal was already there, dressed in red, with other local institution representatives and politicians coming from the capital. The garden was getting always more crowded, full of chairs and local people. We started the celebration of that beautiful day, a special day that was going to give to everybody the possibility to have a new area for the children and their mothers, a great sacrifice to get it, but also an important result for a hospital born from a small health centre which now has become a great point of reference to get health assistance and well known in Dar Es Salaam. The event of that day is still a strong memory inside me, and despite it was getting more and more hot and the sun was getting stronger, in front to those happy people it didn’t matter. Knowing that from that day all of them were going to have access to the Hospital was a special feeling and the best present. Thank you Mbweni!

Andrea Franchella, Director of Operative Unit of Pediatrics Surgery

Professor Franchella, Director of the Operative Unit of Pediatrics Surgery at the Azienda Ospedaliera S. Anna of Ferrara, as well as responsible of pediatrics surgery missions in developing countries, has carried out from the 15th December to the 4th January a surgical mission in our Mbweni Hospital. Together with him, also Doctor Fausto Zanotti (in the project Leader Anesthetist), the pediatrics surgeon Doctor Cosimo Bleve (you can read about his experience on the field in this Newsletter) and Doctor Giuseppina Vozza (in the project 2° anesthetist). An interview with Professor Franchella:

Interviewer: Recently, I read your interview on Il Resto del Carlino, titled “With the scalpel give back a smile
to disadvantage children”. You managed to raise in Italy the attention on what means for a child
living in a developing country being affected by palatoschisis. Every year, more than 165.000
children are born with this deformity of the face. Most of them don’t have access to medical cures.
These children have difficulty in eating in a normaly way, cannot talk, cannot go to school or find a
job. To be born with this deformity of the face in a place like Africa, moreover, means a life of
marginalization and isolation. Many children born with this disease are killed or abandoned, and
their family is often excluded by the social life of the community because considered cursed like the
same deformity.

Andrea Franchella: Exactly for all these reasons the missions we periodically carry out – even with the support of the Mbweni Hospital in collaboration with Associazione Ruvuma Onlus – are of vital importance for the population living in that area. It takes an operation of only 45 minutes to allow a child to go back smiling… 45 minutes that really change the life of a person.Interviewer: Can you tell us about your last experience in the Mbweni Hospital? How many children were
you able to operate?

Andrea Franchella: In this mission, organized by the Onlus of Ferrara Chirurgo e Bambino, we didn’t have patients affected by palatoschisis, but we rather we carried out surgical and urologic operations, in total 39 surgical operations, most of them on children below their 16s.

Interviewer: During these missions, beside carry out surgical operations, do you also work with local doctors?

Andrea Franchella: We always actively work with the doctors and technical staff of the place, at the end the objective is also that of transferring knowledge and make them as independent as possible. In this mission, the preparation of patients for the operation, the management of the operating theatre and post operational cures have all been committed to the local nurses. The sterilisation of the surgical instruments of the operating theatre, for instance, were commited to the scrub nurses. The anesthetists have collaborated with the local anesthetist technician (in the majority of African hospitals there are no anesthetists). In the second part of the mission the operations have been carried out only with the help of the local anesthetist (Youssef Barabara).